I must go to the doctor again. This particular appointment is with the endocrinologist, but I realize that the feelings I’m having are not specific to her. They are part of a pattern existing throughout my adult life: a visit to the doctor is a visit to the land of judgment, silence and apologies.

There was a span of years when I was making this worse because of my active addiction to painkillers. Some doctor visits were preceded by anxious reviewing of my desperate exaggerations or even outright lies, combined with the ever-present shame. One of the blessings of recovery is freedom from these dishonest machinations.

There are also times when my apologies are about not taking my meds properly, as during a severe depressive episode, or failing to carry out some other assignment designed to help me.

However, for most of my adult life, the dragon I face in the doctor’s office has been the same one: being fat. Fat, whether to a greater or a lesser degree, in a medical climate that places almost any ill at the door of one’s weight regardless of other health parameters (and it must be admitted that, although I believe in the Health at Every Size philosophy, it is usually clear that my body would be happier near the lower end of my weight range.)

No doctor, be they primary care or otherwise, has ever failed to inform me that I should lose weight, with the exception of the rare few I only met while at the extreme low end. They tell me this as if I do not know it; as if I have somehow managed to reach middle age without being aware that I am overweight.

Any explanation I might give about why losing weight is not working out at the time, or about regaining it following a loss, sounds like excuses. And I don’t want to make excuses, anyway. I’d really prefer it to be taken as read that I’m aware of the issue and doing my best, even if my best is not what they would like. Still, not an appointment passes–no matter what the presenting problem or how unrelated it might seem–without me having to answer for the size of my body.

This problem is neither new nor unique to me, and I know many awesome people who could give me advice on how to stand up for myself more effectively. I realized lately that much of the problem resides in myself: I don’t present my situation unapologetically because I have not come to terms with it. I haven’t unpacked and dealt with a lifetime of internalized fat prejudice I didn’t realize I was carrying.

The doctor I’m going to see, who wanted me to have lost weight since our last appointment, is one for whom my weight really is a relevant parameter: we are dealing with blood sugars, hormone levels, and other things that are affected by it. I can’t present her with the results she hoped to see. I have to show up as I am and ask her to treat the patient she has, not the patient she wants. I have to be honest with her, and ask her to ally with me in treating my conditions on the assumption that my weight is not going to go down right now.

I would like her to give me advice about focusing on fitness, with the understanding that I may or may not be able to do as much as she wants. I’d like her to pleased with what I do accomplish, even if it’s only managing to take my meds properly and go on a few walks.

Yeah, and I’d also like a pony.

Some of what I want isn’t going to happen. My longing to be understood and respected by those in the medical profession could be a classic example of going back to that dry well. Even as I long for it, I identify with the doctors themselves and the frustration they must experience when patient after patient sickens or dies for lack of following a few “simple” instructions. I feel unworthy of their time. I feel unworthy of the medical care I’m privileged to have available. (The fact that they are providing a service for which I’m paying gets lost in this self-recrimination.)

There’s one thing, however, over which I do have power. That’s the baggage I mentioned above. It’s time for some major unpacking, and the more I think about the topic the clearer and more extreme some of the buried core beliefs are becoming.

I miss you too, whoever you are. Maybe you’re an old classmate that I haven’t seen in years, or maybe it’s only been a month since we took a walk together. But you see, it is not possible for me to see you again. More precisely, it is not possible to let you see me. It is not possible for me to let you see me because of my weight.

Never mind that, if you’ve known me for a while, you have seen me at this weight before. You’ve probably seen me at higher weights–but you may have recently seen me at lower weights too, and that’s what I can’t stand.

Ever since I was 13 years old, I have been defined by my weight. Much of this definition happens in my own mind, although it is helped by some aspects of our culture. Going to college, working at jobs, having a child–all of it was secondary. The mark of my success or failure as a human being was a number on the scale.

The weight gain of the past year, capped off by yet another weight gain in the last couple of months, has me convinced that if I see you, what I will see is a look of horror and disgust on your face as you compare me to the last version of me that you saw.

Every desperate attempt at dieting during the past year has been “rewarded” with a weight gain rather than a weight loss. On the advice of my new psychiatrist, I am switching to a very basic mindful eating plan designed to prevent the extremely destructive binge eating episodes. This means that I have no idea what will happen to my weight–and therefore, I have no idea when I will be able to see you again.

Intellectually, I know that if you consider me a friend of yours, weight fluctuations are nothing new to you. In your mind, it’s probably a part of how you view me. You have seen me everywhere on the spectrum of weight, and you have seen me be inconsistent in how I deal with food. To you, it is probably just a personal characteristic of mine. And, if we’ve been friends for a while, this characteristic of mine is not a dealbreaker for you. You have your reasons for valuing me, and those reasons don’t have to do with me winning some kind of permanent victory against my eating disorder. I know this, intellectually.

Nevertheless, some sort of line has been crossed in the last couple of months. I just cannot see you again until I have somehow met the requirements. It doesn’t matter how many poems I’ve written recently. It doesn’t matter what else I might have done that is interesting. It doesn’t matter that you might enjoy having me listen to you about your life, or that we could laugh and play together.

Now, you know me well enough not to believe 100% of what you just read. You know that I don’t always let that voice win, and that I am capable of facing it down to make contact with another person. I will keep trying, because you matter to me.

My dark phases, hellish as they might be, are not uninterrupted darkness. The grim or lackluster parts are almost always interrupted by moments of grace. Much grace comes from my family, for I am blessed not to live in isolation.

Beyond these everyday blessings, sometimes I get moments. The kind I’ll remember years later. They pierce through the fog and join their neighbors in the innermost vaults of my consciousness, there to be defended to the death.

About ten days ago, I drove about an hour and a half north to go to a poetry reading in Napa County. The reading was held at the town’s library, which like many buildings in the town basically backed up to a vineyard. Lines of comfortable chairs were arranged facing the windows of the main room, and the reading poet was silhouetted against one side of the bright span of windows. While listening, we gazed at the green vines under the slanting sun of a late summer afternoon.

The beauty was so surreal that I began to feel as if I were on another world. I found myself thinking of recent tragedies in the news, and about how much privilege is involved with this tranquil setting, but even the familiar sadness and guilt faded into just being present.

The Moment with a capital M wasn’t only this beauty, though. It wasn’t just the careful packing away and stowing of a lovely memory. No, the magic part came next, in equal parts spirituality and science fiction.

I was struck, suddenly, with a feeling of being apart from the time stream. The concept of parallel timelines exists in many sci-fi universes, and I have been exposed to it long enough for it to be a part of my thinking at times. Right there and then, at that moment, I felt my current timeline brushing against another one. The other timeline was one, probably one of many, in which I was not in that beautiful room because I was not alive.

In that timeline I didn’t live to write any poetry, or read any, or drive to Napa to share some. I died sometime between 2009 and 2011, you see, from a drug overdose or some other self-destructive act. My chair was empty.

It sounds a bit trite as I attempt to describe it: I had a moment of being grateful to be alive, blah blah…but there was something about that empty chair, almost superimposed against the one I was occupying, that made my worries and shames lose power for a moment. The words, the window, the sun were my reality, mine, there as opposed to not there.

There I was, in the middle of this period of depression and poor health, feeling so powerfully alive that all else faded. And when it came my turn to read something of my own, what need was there to fear? The words were mine, my reality, coalesced in this fortunate timeline from ghosts of might-have-beens.

Those who share some of my issues will be relieved to know that I am taking steps to obtain a supply of my bipolar meds again. Having dropped the ball during the previous months and the stresses I’ve been having, I have been without them for nearly a month now…and it’s not good.

At last, I became resigned to using precious funds on a visit to my old psychiatrist, because my plans to find a new one hadn’t panned out and there was no longer any time to lose. However, when I called the number, I found out the practice had just closed. Turns out he is still in practice, but with a new group clinic. So I called the number, and was told I need to go through the standard intake process before I can be given an appointment with him or anyone else. On the bright side, they might be able to match me with someone who will take my insurance for part of the cost.

So, yesterday, I found myself participating in an intake conversation. This feels weird on a couple of levels: first, it always feels overwhelming for me to try to summarize my present and/or past condition (can I just give them the address of this website, please?) Second, the questions on the intake are familiar to me from both ends: before my diagnosis, I worked at a counseling center and did phone intakes regularly.

I know why they have to ask certain questions, and I know what answers they are looking for. I know what red flags they are trying to spot. I know the clinical descriptions of the things they describe. And although I know these things, I need to answer the questions like a patient and not a co-clinician.

Something else about this, for my readers who share my issues with addiction: the intake person asked me about any history of substance abuse. If it hadn’t been on the form, I would have brought it up myself. Whoever I end up seeing will, like my old psychiatrist, be fully informed about my history of addiction and recovery. I can’t overstate how important this is: one of the drugs I used to abuse came from a psychiatrist years ago. It wasn’t their fault, but as a person in recovery it’s my responsibility to make sure doctors of any kind know that certain drugs are not appropriate for me.

At the end of the questions, I was told they need to consult my insurance before they can schedule me an appointment. They will call me back, the intake person said. I promised myself I’d wait at least until tomorrow before calling again, but I feel anxious because some medical “we’ll call you back” things have not gone well lately.

So that’s what’s going on. Nothing very fun or inspirational right now, but I know many of my readers have been there. Part of living with our conditions is sometimes doing that footwork, one step at a time, and dealing with the frustration of not doing it very well.

I am so tired of apologizing, but I don’t see how I can stop doing it. I’m not even sure I want to stop doing it.

I don’t want to live my life as a walking apology, but I also don’t want to become the kind of person who sees no need for regrets about how my condition and/or my shortcomings affect others.

Recently, I was having an interaction with someone that involved me sending an email every day for a certain purpose. I was consistent for a couple of weeks, then skipped days. When my dip ended, I began again, apologizing for my lapse and saying it was okay if they didn’t want to continue. They gave me another chance…and, after some days, it happened again.

It’s only the latest iteration of the type of cycle that defines my life:

Stage 1: I’m back! So sorry I haven’t done the thing for (insert length of time here.) I’m going to try really hard to do the thing again, because the thing is very important to me.

Stage 2: Look, I did the thing. See? I did it some more. I can do the thing. I can do the thing every day. So grateful to be doing the thing.

Stage 3: I am sort of doing the thing, but not well. I’m sorry. Can we talk about this later?

Stage 4: *silence*

Stage 5: Hi. I haven’t been doing the thing. I want to start again and I can’t and what does it matter anyway because I know even if I do it won’t last and I’m sorry, so sorry; I know you must think the thing isn’t important to me but it is, I swear it is, and so are you…

Was it unrealistic of me to even try something that relied upon consistent, daily performance of a task? What if I had said, look, I really want to do this, but I have a mental health issue and a history of interruptions in my functioning? Would that have been being realistic and sensible, or would it be seen as making excuses?

What if I say to my doctor, look, I’d like to nod and smile and tell you I’ll exercise every day, but the only exercise I have been getting during the really bad times is digging through cupboards for band-aids?

Where is the line; where does a realistic assessment of my condition end and making excuses begin?

Could I be allowed to stop making promises, or even implied promises, that set me up for the inevitable apologies?

There’s no way for anyone else to assess, or even for me to assess reliably, the subjective amount of effort I’m making. So how can I, when unable to perform consistently, express that the thing, principle or person is still important?

Can I ever be good enough, do enough, love enough to have it mean something?

These are not new thoughts, and the search for balance will never end. I’ve made progress on some aspects of it. I’m better about not making commitments during my “up” phase that are completely unrealistic, and I’m more forgiving of myself than I used to be. But shame still saps way too much of my energy, and delays the return of good self-care after a dip.

I want to conquer shame and let my apologies be simply an expression of regret–always remembering that an apology means little in the absence of a sincere effort to do better.

I have so much I could be writing about lately, but I haven’t been writing about any of it. I haven’t been writing about any of it because it feels as if it’s not my story to tell. It feels disrespectful to be making personal essays out of events that, while they affected me, affect others so much more.

The last two weeks have seen the end of my relative’s journey on this plane; he died the morning of June 14. I was there during his last hours, and saw him only minutes after he died. Other family members and I sat with his body until the funeral home workers came to transport him, and we watched him be wrapped up and taken away.

I was there, and I had thoughts, and I had feelings…but it’s not really my story. It’s his story, and his wife’s, and his children’s. I know that the feelings I have are nothing compared with how they feel.

It’s not my story…yet, inevitably, it is. It may be the ultimate self-absorption, but my lens is the only one I have. I’m incapable of an omniscient perspective; anything I write about is really about my experience of the thing. Even if I write from the perspective of another character, it’s still my projection being fueled by my attitudes.

So I’m aware of my own self-absorption right now. I’m aware of the part of my brain responsible for interpreting everything happening in terms of “What does this mean to me? How does this change the structure of my inner world? How do these truths apply to my journey?”

I’m judging myself for this. I feel ashamed of spending any mental energy on philosophizing while people I love are in need of comfort. I’m ashamed of the fact that, even while I carry out actions that reflect my desire to comfort them, a part of my mind is off crafting metaphors.

This judgment, however justified it might be, is dangerous. Blocking my personal writing is dangerous. Turning my metaphor factory into a moral issue is dangerous. Yesterday, I found myself tearing pictures out of magazines with a very diagnostic type of focus…my symptoms are rising, and I cannot afford to reject the best and least harmful coping mechanisms I have.

I need to allow myself to feel, and write, and make existential gold out of straw. I need to let myself think about what witnessing a death has made me feel about life, and recovery, and meaning.

You would think I already know that to my bones. I’ve written about the concept of fairness, and how expecting fairness can get us into trouble in recovery or any other parts of life. I know we are promised nothing.

But there are some courses in life we never really complete…there’s always a new layer or dimension to cover. A new way for the lesson to be presented, a new way we need to integrate it into ourselves. So I’m feeling it, learning it; trying to accept it in two new ways lately–one more self-centered than the other.

The self-centered one has to do with what I’ve already talked about…the problem I’m continuing to have with my metabolism. I sought a higher level of support around my sensible eating plan, and it’s been going really well for a couple of weeks now–until I step on the scale and have an experience I can best describe as baffled terror. The math just doesn’t work out right. Even the endocrinologist is puzzled; at our last appointment I presented her with a list of what I’d eaten for the last ten days and she agreed that I shouldn’t cut any more calories.

Abstaining from compulsive eating has always brought me some degree of physical recovery in the past, and it’s hard for me to accept that I must, for the indefinite future, abstain without getting any of those rewards. I know, intellectually, that I am getting rewards in the form of not making things even worse, but it’s hard to feel it when I am scared and ashamed and in pain.

The other way I’ve been exposed to the lesson recently is that my relative, who has been ill for a while, has transitioned into hospice care. I am watching this process, and the effects it has upon my loved ones.

I think death is simultaneously the most fair and the most unfair thing there is. It’s fair because it comes for everyone, but it’s unfair about when and why and how. It’s not merit-based. And when you get right down to it, down into the nuts and bolts of the process of dying a “natural” death, it’s hard not to think that there ought to be a better system for this kind of thing. It’s not fair. It’s not going to be fair.

We all, on some level, think that life should be fair. Hard work and good deeds should be rewarded, evil should have consequences, and our efforts in life should influence the outcome. Even when confronted with countless examples to the contrary, even when we watch others grieve or be persecuted, even when we ourselves suffer, a part of us wants to believe it’s going to be different.

I’m in no hurry to stop believing some parts of that, really. We have to, in order to keep going. I have to think my fight matters. I have to believe my efforts influence the outcome…what I have to let go of is the belief that I can control how they influence it and what the end result will be.

I could die tomorrow, or next year–countless poems unwritten and all of my recovery efforts spent for just a few more years. It wouldn’t be fair. It’s also not fair that I’m alive at all when many of my fellows didn’t survive their active drug addiction.